| Objective:The purpose of this study was to attempt to implement dietary evaluation for gastric cancer patients with nutritional risk,so as to quantify the individualization of preoperative nutritional support method,and to explore the method of through preoperative individualized nutrition support on nutritional risk of postoperative gastric cancer patients nutrition status,the degree of inflammation,gastrointestinal recovery,complications,postoperative hospital stay,and the influence of the total cost of hospitalization.In order to optimize the methods of perioperative nutritional supplement for gastric cancer patients with nutritional risk,accelerate the rehabilitation of patients,improve the attention of surgeons to preoperative nutritional support,and provide theoretical and practical basis for promoting the rehabilitation of patients.Methods:This study prospectively selected patients who underwent radical gastrectomy for gastric cancer in the Department of General Surgery of Lanzhou University Second Hospital from October 2020 to October 2021,and carried out NRS-2002 nutritional risk detection within 24 hours of admission.A total of 100 patients with nutritional risk（NRS-2002≥3 points）were screened.Randomly divided into experimental group and control group according to random number table method.There were 50 cases in each group.The experimental group:the total caloric intake of bedridden patients was 30kcal/（kg·d）,and that of ambulatory patients was35kcal/（kg·d）,and protein intake was 1.2g/（kg.d）.Doctors evaluated the daily diet status of patients through Simple Diet Self-Assessment Tool（SDSAT）（northwest edition）,estimated the intake status,including energy and various nutrients,and formulated individualized nutrition support plans according to the diet status of patients.On the basis of preoperative routine diet education,3 ～7d whole protein preparation containing dietary fiber was taken orally（national food note: TY2020002,model:400g/jar,1827 KJ of energy added per 100 g,18g of protein）.Oral nutritional supplementation（ONS）were restored within 24 h postoperatively,and the deficiency was supplemented by Enteral Nutrition（EN）or Parenteral Nutrition（PN）;the control group: Preoperative routine diet education,and the postoperative plan was the same as the experimental group.Observed two groups of hospital 1 day,1 day after surgery and postoperative day 7 of weight,calf circumference（CC）,grip strength（HGS）,peripheral blood albumin（ALB）and prealbumin（PA）,lymphocyte count（LC）and white blood cell count（WBC）and C-reactive protein（CRP）,electrochemical immunoassay detection of peripheral blood interleukin-6（IL-6）,and the effect of first postoperative exhaust time,first postoperative defecation time,postoperative complication rate,postoperative hospitalization time,postoperative albumin use and total hospitalization cost.Results:1.A total of 100 patients were included in this study,50 in the experimental group and 50 in the control group.The average age,gender,admission weight and BMI,history of diabetes,history of hypertension,history of abdominal surgery,surgical method,upper digestive tract reconstruction method,tumor location,TNM stage,number of lymph node metastasis,Lauren classification,C-erbb-2 expression,tumor diameter and other general data of the two groups were compared.There were no statistically significant differences（P>0.05）;2.There were no statistically significant differences in body weight and CC between the two groups from the 1st day of admission to the 7th day after surgery（P>0.05）.The levels of HGS,PA and LC in 2 groups decreased on postoperative day1,and the levels in experimental group were higher than those in control group（P<0.05）.On the 7th day after surgery,the levels of HGS,ALB,PA and LC in both groups increased gradually,and the levels in experimental group were higher than those in control group（P<0.05）;3.The indexes of postoperative inflammatory response in both groups were higher than those before surgery,and the indexes increased significantly on the 1st day after surgery,and gradually decreased on the 7th day after surgery.The levels of CRP,WBC and IL-6 in the control group were higher than those in the experimental group on the first postoperative day（P<0.05）.The levels of CRP,WBC and IL-6 in the control group were also higher than those in the experimental group on the 7th day after operation（P<0.05）;4.The first postoperative exhaust time in the experimental group was shorter than that in the control group（P<0.05）,the first postoperative defecation time in the experimental group was shorter than that in the control group（P<0.05）;5.There was no significant difference in the incidence of postoperative complications between the two groups（P>0.05）.None of the patients in either group died;6.More patients were treated with albumin in the control group than in the experimental group（P<0.05）.The hospitalization time of experimental group was shorter than that of control group（P<0.05）.There was no significant difference in total hospitalization cost between the two groups（P>0.05）.Conclusions:1.Preoperative individualized nutritional support can improve the nutritional status of gastric cancer patients with nutritional risk.2.Preoperative individualized nutritional support can reduce the inflammatory response in gastric cancer patients with nutritional risk.3.Preoperative individualized nutritional support is beneficial to postoperative gastrointestinal function recovery of gastric cancer patients with nutritional risk.4.Individualized nutritional support before surgery can shorten the postoperative hospital stay of gastric cancer patients with nutritional risk.5.Preoperative individualized nutritional support did not reduce the incidence of postoperative complications in gastric cancer patients with nutritional risk,nor did it increase their total hospitalization costs.6.The simple dietary self-assessment tool can effectively quantify nutritional support programs and is feasible in gastric cancer patients. |
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